September 27th, 2012 marked the fifth observance of National HIV/AIDS and Aging Awareness Day. It is a day where we recognize that while the progress made in reducing HIV mortality and morbidity is remarkable, people aging with HIV face multiple, unique challenges. By 2015 over half of all people living with HIV in the US will be over age 50. A major reason for the ‘greying’ of HIV in the US is due to the tremendous success of medications that have dramatically increased the lifespans of people living with HIV.

About 10% of new HIV infections in the United States occur among persons over 50. HIV prevention among older adults is complicated because clinicians are less likely to consider the possibility of HIV infection in this population. Part of the reason for this is that the overwhelming majority of new HIV infections in the US occur among younger populations. However, decreased testing rates mean that older adults are more likely than younger adults to be diagnosed later in their disease progression (i.e. more likely to be diagnosed with AIDS less than a year after diagnosis).

Racial and ethnic disparities observed in the US HIV epidemic overall are reflected among older persons living with HIV. The rates of HIV/AIDS among people over 50 are 12 times higher for African-Americans and 5 times higher for Latinos compared with whites, which has implications for life expectancy as well as HIV transmission because black and Latino populations generally are less likely to have access to clinical care.

While more people aging with HIV are living healthier, more productive lives than ever before, growing older with HIV may present multiple medical challenges. Because the immune systems of people living with HIV are constantly fighting infection, they are more prone to ongoing inflammation which is associated with co-morbid conditions associated with aging such as diabetes, heart disease, hypertension, and cancer. Liver disease, often the result of co-infection with hepatitis C, is prevalent. Decreased bone density is also common, potential due to combination of the normal aging process, medication side effects, and the direct effects of the virus itself

Over the past several years, the US government has drawn attention to the issue of HIV and aging. In 2010, President Obama released the first comprehensive National HIV/AIDS Strategy for the United States. HIV and aging was among the issues outlined in the Strategy. The Department of Health and Human Services (HHS) Administration on Aging (AoA), the US Department of Veterans Affairs (VA) as well as the National Institutes of Health (NIH) have also moved the HIV and aging agenda forward.

In the past year, HHS AoA held a webinar on (The Graying of HIV/AIDS) to provide information on seniors living with HIV and seniors at risk for HIV. HHS AoA also produced and released a toolkit to inform older adults about HIV risks and to encourage older adults to know their HIV status. The VA continues to be at the forefront of HIV and research through ongoing implementation of the Veterans Aging Cohort Study (VACS). VACS, a study that includes HIV-positive as well as HIV-negative veterans, follows participants over time and evaluates the health of veterans. Much of what we have learned about HIV and aging has arisen from VACS analyses.

HIV and aging has also been a major focus at National Institutes of Health (NIH). Over the past year, the NIH has released several research funding announcements specific to HIV and aging and in July NIH released HIV and aging was one of the topic areas during the International HIV/AIDS Conference. In addition, the NIH Office of AIDS Research recently released a report on HIV and aging. The comprehensive report, based upon consultation from an expert working group, 1) summarizes knowledge and state the problem in research area; 2) identifies priority research areas; 3) points out specific knowledge gaps; and 4) suggest research to address gaps.

Progress has been made in research and programs with regard to aging and HIV, but more remains to be done. As part of the National HIV/AIDS Strategy, Federal efforts will continue to help people aging with HIV not only live longer, but maximize their health and wellness.

Dr. Grant Colfax is the Director of the Office of National AIDS Policy.